Hi Guys, I was in Delhi last week consulting with Doctors about lengthening. I met Manish Dhawan and Naveen Talwar. I'm confused which option to with, and need your suggestions.
Consultation with Manish Dhawan -
He took me to an empty room and asked me to remove my trousers and walk. He suspected that I might have bow legs and asked me to go get an X-Ray. Once he examined the X-Ray, he said that I have slight bow legs and cannot perform LON as the bow leg would prevent it. He said I need to go with TSF to correct the bow leg. He said he would do plating post lengthening if I don't want to wear the frames during consolidation. Lengthening limit is 7 cms. Total cost using TSF would come to around 12 lacs in Rupees, or about 20k in USD.
Dr Dhawan said the same thing to me about being unable to do much bone adjustment with LON.
The TSF is expensive to apply. I know Dr Dhawan has access to and is able to use the hexapod for six-axis correction. It does the exact same thing as the TSF but the hexapod struts can be attached to a standard Ilizarov frame and are made locally, so they are far less expensive to apply. I wore the hexapod struts for a few days to correct misalignment after lengthening. You can see what they look like in this post of my Patient Experience:
http://www.limblengtheningforum.com/index.php?topic=634.msg18873#msg18873You should see what he says about using the hexapod and report back his reply. When I was there in 2014 he quoted "approximately $10,000" for hexapod and that's when the exchange rate between INR and USD wasn't as much in our favor. There's no reason you need to shell out more for a TSF in particular, imo.
Edit: Have you asked Dr Dhawan his thoughts on Dr Talwar? I know he knows Dr Talwar personally because Talwar used to work at Sir Ganga Ram Hospital.
Consultation with Naveen Talwar -
I met him at his clinic in Defence colony. He said he doesn't recommend to lengthen Tibia. Instead, he recommended to go with Femur lengthening using monorail. He said safe limit is 6 - 8 cms, and if I want more he do 10cms. He referred me to a different doctor (Dr. Bedi) in Fortis hospital in Vasant Kunj.
I met Dr. Bedi next day. What I heard from him is quite contrary to Talwar's suggestion. He examined my joints, muscle stiffness and said femur lengthening is not advisable for me because I'm very muscular. He said the safe limit for me is 3.5 cms in Tibia. He told that they use monorail for lengthening, and plating post distraction. If my body permits, he said he can do 5cms, but he said I shouldn't aim above 5cms.
I asked if monorail is a good option for me due to the bow legs. He said I have slight misalignment and it can be fixed during the surgery. I then called Talwar and explained everything. I asked him to check with Dr. Bedi and provide his final thoughts, and said I'll call in the evening.
In the evening, Dr Talwar said that Dr. Bedi is right and I would have to do Tibia. He also said that he wants to do 7-9 cms on me, instead of 3.5 cms suggested by Bedi, as I'm too short (my height is 5'4''). He said that he would perform achilles tendon lengthening, which can give me the muscle flexibility to go 7-9 cms. I asked him about the bow legs and he said that normally he wouldn't do anything to it as there is not much bowing. However, if I insist, he said he can add an extra pin to the monorail and fix the bow legs during lengthening. Cost of the procedure is around 5 lacs in Rupees or about 10k USD.
The doctors at Rockland all seem to prefer using monorails, finding them more comfortable for the patient and simpler to apply. But both Dr Dhawan and Dr Parihar advised me against using them.
Dr Dhawan: Said he would not do externals with monorails because you cannot change its axis, whereas with the hexapod everything is under his control. Believes that a good surgeon would not choose to use monorails for cosmetic cases. It was pretty funny because when I asked about using monorails he said "Why do you want to go and f*** yourself?"
Dr Parihar: He has used monorail fixators for lengthening before, but said the disadvantage of using it over the Ilizarov fixators is that there is nothing to hold the foot. With Ilizarov fixators, if you develop trouble in terms of equinus you can use rings to get the foot straight by gradual stretching. With monorails you have nothing to hold the foot. Although monorails superficially look easier, he finds them more complicated than Ilizarov because you have to be absolutely perfect with it, or you can run into other complications. He said that as a general rule, bulkier patients almost always have a tendency to develop valgus deformity with monorails. The monorails are pulling only from one side of the tibia and the monorail doesn't get much of a hold on the soft tissues on the other side, especially with bulkier patients, whereas with ring fixators you've got a hold on both sides. So he much prefers the standard Ilizarov frame for cosmetic lengthening.
Edit: Because the thighs have more muscle surrounding the femur you have a lot more muscle scarring with external femur lengthening, and this risks lots of function like losing the range of motion in your knee. It's also a lot more painful according to those who have done it.
My Questions:-
I want to go with Talwar because monorail is very comfortable as compared to TSF ring. However, I'm having trouble believing that monorail can fix bow legs, by adding an extra PIN.
I'm no orthopedist, but I'm having a hard time imagining how adding a pin will help fix bow legs. When I had extra pins added they were to increase the stability of the bone. Also, 7-9 cm on tibiae is too much, imo. Others will disagree, though.
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Topic: Consultation with Manish Dhawan and Naveen Talwar (Read 4997 times)